Healthcare Provider Details

I. General information

NPI: 1700343795
Provider Name (Legal Business Name): CRYSTAL L KUHN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

V. Phone/Fax

Practice location:
  • Phone: 770-343-8760
  • Fax: 770-292-3121
Mailing address:
  • Phone: 770-343-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN249141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: